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个体化急性肾损伤后护理。

Individualized acute kidney injury after care.

机构信息

Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois, USA.

Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, UK.

出版信息

Curr Opin Crit Care. 2020 Dec;26(6):581-589. doi: 10.1097/MCC.0000000000000779.


DOI:10.1097/MCC.0000000000000779
PMID:33027144
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8016399/
Abstract

PURPOSE OF REVIEW: The aim of this study was to summarize the current evidence around the impact of individualizing patient care following an episode of acute kidney injury (AKI) in the ICU. RECENT FINDINGS: Over the last years, evidence has demonstrated that the follow-up care after episodes of AKI is lacking and standardization of this process is likely needed. Although this is informed largely by large retrospective cohort studies, a few prospective observational trials have been performed. Medication reconciliation and patient/caregiver education are important tenants of follow-up care, regardless of the severity of AKI. There is evidence the initiation and/or reinstitution of renin-angiotensin-aldosterone agents may improve patient's outcomes following AKI, although they may increase the risk for adverse events, especially when reinitiated early. In addition, 3 months after an episode of AKI, serum creatinine and proteinuria evaluation may help identify patients who are likely to develop progressive chronic kidney disease over the ensuing 5 years. Lastly, there are emerging differences between those who do and do not require renal replacement therapy (RRT) for their AKI, which may require more frequent and intense follow-up in those needing RRT. SUMMARY: Although large scale evidence-based guidelines are lacking, standardization of post-ICU-AKI is needed.

摘要

目的综述:本研究旨在总结目前关于 ICU 急性肾损伤(AKI)后个体化患者护理对患者的影响的证据。

最近发现:在过去几年中,证据表明 AKI 后的随访护理不足,可能需要对该过程进行标准化。尽管这主要是基于大型回顾性队列研究,但也进行了一些前瞻性观察性试验。药物重整和患者/照护者教育是随访护理的重要内容,无论 AKI 的严重程度如何。有证据表明,肾素-血管紧张素-醛固酮系统药物的启动和/或再使用可能改善 AKI 患者的预后,尽管它们可能增加不良事件的风险,尤其是在早期重新使用时。此外,在 AKI 发生后 3 个月,血清肌酐和蛋白尿评估可能有助于识别在接下来的 5 年内可能进展为慢性肾脏病的患者。最后,需要肾脏替代治疗(RRT)和不需要 RRT 的 AKI 患者之间存在差异,这可能需要对需要 RRT 的患者进行更频繁和更强化的随访。

总结:尽管缺乏大规模的循证指南,但需要对 ICU 后 AKI 进行标准化处理。

相似文献

[1]
Individualized acute kidney injury after care.

Curr Opin Crit Care. 2020-12

[2]
Long-term outcome in ICU patients with acute kidney injury treated with renal replacement therapy: a prospective cohort study.

Crit Care. 2016-8-12

[3]
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[4]
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[5]
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[6]
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[7]
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[8]
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[9]
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[10]
The impact of "early" versus "late" initiation of renal replacement therapy in critical care patients with acute kidney injury: a systematic review and evidence synthesis.

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引用本文的文献

[1]
Using vascular biomarkers to assess heart failure event risk in hospitalized patients with and without AKI.

BMC Nephrol. 2025-6-2

[2]
Self-Reported Burden and Health-Related Quality of Life in Acute Kidney Injury Survivors Compared with Patients with Advanced CKD.

Kidney360. 2025-5-1

[3]
Primary Care Providers Barriers, Comfort and Awareness in Follow-up Care of Acute Kidney Injury Patients: A Comprehensive Survey on Current Practices.

Can J Kidney Health Dis. 2024-12-13

[4]
Discharge Documentation and Follow-Up of Critically Ill Patients With Acute Kidney Injury Treated With Kidney Replacement Therapy: A Retrospective Cohort Study.

Front Med (Lausanne). 2021-9-14

[5]
Long-term kidney function of patients discharged from hospital after an intensive care admission: observational cohort study.

Sci Rep. 2021-5-11

本文引用的文献

[1]
Effect of nephrology follow-up on long-term outcomes in patients with acute kidney injury: A systematic review and meta-analysis.

Nephrology (Carlton). 2020-8

[2]
Post-Acute Kidney Injury Proteinuria and Subsequent Kidney Disease Progression: The Assessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) Study.

JAMA Intern Med. 2020-3-1

[3]
A prospective multi-center quality improvement initiative (NINJA) indicates a reduction in nephrotoxic acute kidney injury in hospitalized children.

Kidney Int. 2020-3

[4]
Renin-Angiotensin System Blockade after Acute Kidney Injury (AKI) and Risk of Recurrent AKI.

Clin J Am Soc Nephrol. 2020-1-7

[5]
One-Year Prognosis of Kidney Injury at Discharge From the ICU: A Multicenter Observational Study.

Crit Care Med. 2019-12

[6]
Timing of Recovery From Moderate to Severe AKI and the Risk for Future Loss of Kidney Function.

Am J Kidney Dis. 2019-9-16

[7]
Use of Cell Cycle Arrest Biomarkers in Conjunction With Classical Markers of Acute Kidney Injury.

Crit Care Med. 2019-10

[8]
Incidence, Risk Factors, and Outcomes of Transition of Acute Kidney Injury to Chronic Kidney Disease in Cirrhosis: A Prospective Cohort Study.

Hepatology. 2020-3

[9]
Impact of AKI on Urinary Protein Excretion: Analysis of Two Prospective Cohorts.

J Am Soc Nephrol. 2019-6-24

[10]
Quality Improvement Goals for Acute Kidney Injury.

Clin J Am Soc Nephrol. 2019-5-17

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